Il ruolo della fissazione esterna nel trattamento delle fratture extracapsulari del collo del femore dell’anziano

Abstract

External fixation is an osteosynthesis technique universally recognised by the International Scientific Community and, according to many, it is the gold standard of treatment. Lateral femoral neck fractures, owing to the extraordinary scientific and epidemiological importance they have in orthopaedic traumatology, have historically been a privileged subject of studies on several fixation and osteosynthesis techniques. Within the various osteosynthesis systems (diaphyseal intra- or extramedullary), external fixation systems belong to the category of diaphyseal extramedullary osteosynthesis. The goals sought by users of this method are mainly three: a significant reduction in blood loss, surgical times and, as a consequence, hopefully in shorter hospital stays; external fixators are used in case of debilitated patients or of complex clinical conditions. A reduced rate of mechanical complications as compared to traditional osteosynthesis systems was not easy to demonstrate owing to the difficulty of defining comparison criteria between the two systems. In addition to biomechanical problems, the unfavourable aspects in the clinical management of this method include the high rate of superficial infections near the pins and poor patient tolerability. The analysis of the literature did not show significant elements in favour of external fixation as concerns the type of fracture, potential long-term functional benefits, postoperative mortality rate, thus suggesting the use of this method in a very limited number of cases, with a poor expected outcome. The literature and international case studies on osteosynthesis in fractures of the femoral neck show a steady increase in the use of diaphyseal intramedullary osteosynthesis (nailing systems) which, in some Countries, accounts for nearly all femoral neck surgical procedures.